The establishment of regional extension centers, or RECs, in 2010 was widely seen as an opportunity for physicians, including family physicians, to more quickly and effectively adopt health information technology, or health IT, and use it in a meaningful way. The reality, however, is that although some FPs have found their REC to be a critical resource in extending their use of health IT, others have found their REC provides spotty service, at best.
RECs grew out of language in the Health Information Technology Economic and Clinical Health, or HITECH, Act. That bill, which was part of the American Recovery and Reinvestment Act of 2009, called for the creation of at least one REC in each state. Administered by the Office of the National Coordinator for Health Information Technology, or ONC, the nationwide initiative(www.healthit.gov) is designed to help America's physicians make the transition to electronic health records, or EHRs.
The last of the 62 RECs in the United States was up and operating by the end of 2010, and, according to the ONC(www.hhs.gov), more than 100,000 primary care health professionals were signed up to work with their individual RECs to adopt EHR technology by the end of November. RECs are "playing an integral role in helping providers on the path to EHR adoption," said Farzad Mostashari, M.D., director of the ONC. He called the news a "compelling milestone" that could lead to improvements in the provision of health care nationwide.
According to Parmeeth Atwal, J.D., M.P.H., a member of the ONC's communications and outreach team, the government allocated $720.9 million to the REC program with a goal of enabling 100,000 primary care health professionals to attest to meaningful use of their EHR systems by 2014.
- Regional extension centers, or RECs, which were set up by the federal government to help physicians achieve meaningful use of electronic health records, or EHRs, have been operating for about year now.
- HHS recently announced that 100,000 providers had committed to EHR implementation with assistance from RECs.
- Family physicians have found mixed success in working with RECs. Some have been extremely satisfied, but others have found their local REC less than helpful.
Christopher Tashjian, M.D., of Ellsworth, Wis., says he has been more than pleased with the assistance he's receiving from Wisconsin's REC. He noted that the REC was "invaluable" in helping him attest to meaningful use of his EHR last April.
The result was that, in June, Tashjian and his colleagues at the five clinics that comprise Western Wisconsin Medical Associates began receiving bonus checks for fulfilling the requirements of stage one of the Medicare or Medicaid EHR Meaningful Use Incentive Program(www.healthit.gov).
The REC Tashjian worked with, the Wisconsin Health Information Technology Extension Center, is a division of a state quality improvement organization called MetaStar that already had an established track record with Tashjian's Ellsworth Medical Clinic.
MetaStar, which was awarded more than $10 million in federal grant money, is the only REC in Wisconsin. It provides resources to more than 150 organizations that represent more than 1,600 health care professionals, according to Jesi Wang, vice president of MetaStar quality resources.
She noted that MetaStar's mission is to improve the quality of health care in Wisconsin. "We've been around for a while, and ours is a not a short-term, but a long-term, commitment," Wang added.
The federal government subsidizes 90 percent of the cost of each REC's services to physicians, said Wang, and RECs also may charge fees for their services. In the case of MetaStar, fees vary according to the amount of help an individual practice needs. "The most we charge for a primary care practice is a $1,000 base fee and $600 per physician or midlevel (provider), but a lot of our services are free," said Wang, who is a certified professional in health IT, EHRs and health quality. "We're there to guide physicians through the process relative to meaningful use," she said.
In most states, family physicians have only one option when it comes to choosing a regional extension center, or REC. However, Jason Mitchell, M.D., assistant director of the AAFP's Center for Health IT, said there are questions family physicians should ask their RECs before signing on the dotted line.
- Does the state REC have a relationship with the AAFP constituent chapter in the state? Extension centers that have working relationships with chapters show good internal organization and a willingness to reach out to an existing organization for feedback and advice, said Mitchell. "If the REC is working with the chapter, that's a good sign. It means the extension center probably knows something about family medicine and has an idea about the kind of help primary care physicians are going to need."
- Does any segment of the REC organization have a track record? Tracking past success is difficult, said Mitchell because most RECs are aggregates of multiple organizations. "Often, these groups have never worked together before but now are tied together by federal regulation," he said. "Ask if any segment of the REC -- from the foundational organization on up -- has a proven track record in practice improvement or electronic health record, or EHR, implementation," said Mitchell.
- What is the cost of the REC's services? Participation fees vary widely. In some areas, the REC provides its services free, but in other states, physicians may have to spend hundreds of dollars. "If it's free, you have some flexibility, but if the REC is charging you real dollars, then it needs to come out of the gate ready to go," said Mitchell. "And if the cost is more than about $750, it's probably higher than the national average. In that case, you may want to consider if that organization is working efficiently and if it really is there to serve you."
- Has the REC hired staff with expertise adequate for the job? "Extension centers should be staffed with people who understand how physician practices operate and who have the credentials to help physicians transform their practices," said Mitchell. "This is not just about adopting EHRs; it's about fundamental practice transformation. If your local REC representative is a former pharmaceutical sales rep, that's probably not a good sign that he or she has the right experience to help you."
- Lastly, ask about your REC's successes. "We're now six to eight months into the attestation process," said Mitchell. "It's fair to ask a REC how many practices it has successfully guided through meaningful use attestation."
Wang noted that she and her colleagues spend a lot of time fielding questions from physicians and getting answers from the ONC, which has helped to build their credibility. The REC also works with vendors to ensure their EHR products are performing as claimed and are collecting the information physicians need to achieve meaningful use. According to Wang, MetaStar never accepts money from EHR vendors, and it does not engage in steering physicians to certain products.
"We're vendor-neutral but not vendor-stupid," said Wang. Rather than turn a practice away from a particular EHR product, she works to connect that group with a similar practice already using that EHR system. "Our job is not to make decisions for a practice, but to give them the information they need to make the right decisions."
According to Tashjian, Wang and her team of 10 were well prepared and highly qualified to help his practice attest to meaningful use. "No question, they knew what they were doing from day one," he says.
Although Tashjian's practice had a head start on meeting its meaningful use objectives -- out of the 15 core objectives(www.healthit.gov) for meaningful use, they already had completed 10 -- "We looked to the REC for help with the other five," he says.
Tashjian's experience with MetaStar was so positive that he urges other family physicians engaged in the meaningful use program to contact their RECs. "Gaining access to the expertise of the REC is invaluable in setting up and maintaining your EHR and getting through meaningful use," he says.
Success with the REC program varies, however, and, in some instances, the message about the assistance a REC can provide to a practice hasn't gotten through to family physicians. For example, David Johnson, M.D., of Rapid City, S.D., only recently read about RECs in messages submitted to an Academy e-mail discussion group. Despite being an important player in his multispecialty group's EHR implementation, Johnson told AAFP News Now, "I'm quite sure we haven't at all been involved in that, and, frankly, I don't even know what a REC is or how it would benefit us."
Ronald Baird, D.O., of Bangor, Pa., said he was excited when he learned last year that government funds had been allocated to help small practices like his achieve meaningful use. Baird had already decided on the EHR product that best suited his practice's needs, but he needed some expert advice on how to use his EHR.
Baird was disappointed, however, to learn that the REC representative to whom he had been assigned was new to the job, had no background in EHRs and had never heard of Baird's EHR system. The staff person already had a heavy client load and encouraged Baird to delay the start of his three-month attestation period.
The information discouraged Baird from proceeding with a partnership with the REC.
"They (the REC) wanted us to pay $800 up front, and the guy didn't have any experience," said Baird, who has since implemented his EHR on his own and will attest to meaningful use in 2012.
Baird's encounter, which occurred shortly after his local REC opened for business, might have had a more positive outcome had it happened today, as local RECs work the kinks out of their programs and learn more about what their clients need.
Jason Mitchell, M.D., assistant director of the AAFP's Center for Health IT, confirms that the REC program's quick uptake proved challenging in some regions of the country. "Finding individuals with the skill set to assist a practice through a technology and health care transformation for the limited resources available and at the scale expected by the REC program has been difficult," says Mitchell. "A single facilitator may be responsible for 40-50 practices."
The ONC's Atwal said that even though all RECs are charged with providing a specific scope of services to practices, who they hire and how they accomplish their work "may vary depending on the market." Accordingly, that means that REC expertise varies from state to state.
According to Atwal, all RECs are charged with assisting physicians with
- education and outreach,
- vendor selection and group purchasing,
- EHR implementation and project management,
- practice and workflow redesign,
- privacy and security best practices,
- progress toward achieving meaningful use, and
- local workforce support.
"It is the REC's role to meet providers where they are and work within these parameters to ensure the services delivered best meet their provider market needs," said Atwal.
The REC program is so new that best practices have not yet been developed, but Wang noted that her REC intentionally hired people with skill sets that went beyond expertise with EHRs. "When we hired staff, we also looked for people who were able to build rapport with practices and who were able to do research to get their physicians' questions answered," she said, adding that this approach has helped with their success providing assistance to physician practices.